Fracture plates, systems, and methods

ABSTRACT

Devices, systems, and methods of bone stabilization. The bone stabilization system includes a bone plate having an upper surface and a lower surface configured to be in contact with bone, the bone plate having an opening extending from the upper surface to the lower surface. The opening is configured to receive a fastener, which may be either a locking fastener or a compression fastener.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 15/587,473, filed May 5, 2017, which is a continuation-in-partof U.S. patent application Ser. No. 15/420,143, filed Jan. 31, 2017,which is a continuation-in-part of U.S. patent application Ser. No.15/405,368, filed Jan. 13, 2017, which is a continuation-in-part of U.S.patent application Ser. No. 15/238,772, filed Aug. 17, 2016, all ofwhich are hereby incorporated by reference in their entireties for allpurposes.

FIELD

The present disclosure relates to surgical devices, and moreparticularly, stabilization systems, for example, for traumaapplications.

BACKGROUND

Bone fractures are often repaired by internal fixation of the bone, suchas diaphyseal bone, including tibia and fibula bones, using one or moreplates. The plate is held against the fractured bone with screws, forexample, which engage the bone and heads which provide a compressiveforce against the plate. The plate and bone are thus forced against eachother in a manner that transfers load primarily between a bonecontacting surface of the plate and the bone surface to reinforce thefractured bone during healing. This manner of plating generally createsrelatively low stress concentration in the bone, as there may be a largecontact area between the plate and the diaphyseal bone surfacepermitting transfer of load to be dispersed. There may be a desire touse locking screws, non-locking screws, or a combination of both thatare able to dynamically compress the bone. Of course, the designs of theplates, types of screws, and locking and/or non-locking capabilities mayvary based on the location and type of fracture.

Accordingly, there is a need for plating systems that providestabilization to the appropriate anatomical area while providingappropriate locking and/or unlocking capability for dynamic compressionof the bone.

SUMMARY

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used to limit the scope of the claimed subject matter.

According to embodiments, a stabilization system may include a pluralityof plates configured to fix bone in the treatment of ankle fractures.Anatomic bone plates facilitate the well-known and established treatmentmethods for bone fractures. An advantage of the exemplary stabilizationsystems is the availability to use various treatment options. It isoften a surgeon's preference whether to use a screw or a suture buttonsystem to repair a syndesmosis, and it is advantageous to provide aplate that can accept either.

In one embodiment, the stabilization system comprises a bone platehaving an upper surface and a lower surface configured to be in contactwith bone. The bone plate has a through-opening extending from the uppersurface to the lower surface. The through-opening includes a threadedportion proximate to the lower surface and a non-threaded portionproximate to the upper surface. A fastener is configured to engage thethrough-opening and to secure the bone plate to the bone. Thethrough-opening is configured to receive one of a locking fastener and acompression fastener.

In an alternative embodiment, the stabilization system comprises a boneplate having an upper surface and a lower surface configured to be incontact with bone. The bone plate has a through-opening extending fromthe upper surface to the lower surface. The through-opening includes athreaded portion proximate to the lower surface and a non-threadedportion proximate to the upper surface. A locking fastener is configuredto be received by the through-opening and configured to be inserted intothe bone. The locking fastener has a threaded head portion configured tolock to the bone plate. A compression fastener is configured to bereceived by the through-opening and configured to be inserted into thebone. The compression fastener has a substantially smooth portionconfigured to dynamically compress the bone.

In still another alternative embodiment, a stabilization systemcomprises a bone plate having an upper surface and a lower surfaceconfigured to be in contact with bone. The bone plate has athrough-opening extending from the upper surface to the lower surface.The through-opening is formed by at least three different co-axial boresincluding a first bore having an internal thread and a first diameter; asecond bore having an unthreaded conical side wall and a seconddiameter, greater than the first diameter; and a third bore having anannular surface surrounding the side wall and a third diameter, greaterthan the second diameter.

In another embodiment, a stabilization system comprises a bone platehaving an elongate body extending from a proximal end to a distal endalong a longitudinal axis and having an enlarged head portion proximatethe distal end, wherein the bone plate is generally symmetric about thelongitudinal axis, the bone plate having an elongated slot located alongthe longitudinal axis having a length greater than its width, the boneplate having a plurality of syndesmotic openings located along thelongitudinal axis, wherein one of the syndesmotic openings is locatedadjacent to the elongated slot, the syndesmotic openings being sized anddimensioned to accept a suture button, a non-locking screw, or a lockingscrew, and the bone plate having a plurality of openings in the enlargedhead portion.

In yet another embodiment, a stabilization system comprises a bone platehaving an elongate body extending from a proximal end to a distal endalong a longitudinal axis and having an enlarged head portion proximatethe distal end, wherein the bone plate is symmetric about thelongitudinal axis, the bone plate having first and second stackedopenings located along the longitudinal axis and positioned proximate tothe proximal end of the bone plate, the first and second stackedopenings configured to accept either locking or non-locking fasteners,the bone plate having an elongated slot located along the longitudinalaxis having a length greater than its width, wherein the elongated slotis located adjacent to the second stacked opening, the bone plate havinga plurality of syndesmotic openings located along the longitudinal axis,wherein one of the syndesmotic openings is located adjacent to theelongated slot, the syndesmotic openings being sized and dimensioned toaccept a suture button, a non-locking screw, or a locking screw, and thebone plate having a plurality of openings in the enlarged head portion.

Also provided are additional stabilization systems, bone plates, methodsfor installing the stabilization systems, and kits including boneplates, fasteners, and components for installing the same.

BRIEF DESCRIPTION OF THE DRAWINGS

Other aspects, features, and advantages of the present invention willbecome more fully apparent from the following detailed description, theappended claims, and the accompanying drawings in which like referencenumerals identify similar or identical elements.

FIG. 1A is a perspective view of a lateral distal fibula plate accordingto a first exemplary embodiment;

FIG. 1B is an enlarged view of a distal end of the lateral distal fibulaplate shown in FIG. 1A affixed to a bone;

FIG. 2A-2C is an alternative lateral distal fibula plate according toanother embodiment;

FIG. 3A is a sectional view of a first (shaft) through-opening extendingthrough the lateral distal fibula plate shown in FIG. 1A with anon-locking fastener inserted in the through-opening;

FIG. 3B is a sectional view of the first through-opening extendingthrough the lateral distal fibula plate shown in FIG. 1A with a lockingfastener inserted in the through-opening;

FIG. 4 is a sectional view of a second (syndesmotic) hole extendingthrough the lateral distal fibula plate shown in FIG. 1A;

FIG. 5 is an x-ray showing the lateral distal fibula plate shown in FIG.1 fixed to a broken fibula;

FIG. 6A is a perspective view of a posterolateral distal fibula plateaccording to a second exemplary embodiment;

FIG. 6B is an alternative version of a posterolateral plate according toanother embodiment;

FIG. 7 is a perspective view of a hook plate according to a thirdexemplary embodiment;

FIG. 8 is an enlarged perspective view of a distal end of the hook plateshown in FIG. 7 ;

FIG. 9 is a side elevational view of the distal end of the hook plateshown in FIG. 8 ; and

FIGS. 10A-10B depict a universal distal fibula plate according to yetanother embodiment.

DETAILED DESCRIPTION

In the drawings, like numerals indicate like elements throughout.Certain terminology is used herein for convenience only and is not to betaken as a limitation on the present invention. The terminology includesthe words specifically mentioned, derivatives thereof and words ofsimilar import. The embodiments illustrated below are not intended to beexhaustive or to limit the invention to the precise form disclosed.These embodiments are chosen and described to best explain the principleof the invention and its application and practical use and to enableothers skilled in the art to best utilize the invention.

Reference herein to “one embodiment” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment can be included in at least one embodiment of theinvention. The appearances of the phrase “in one embodiment” in variousplaces in the specification are not necessarily all referring to thesame embodiment, nor are separate or alternative embodiments necessarilymutually exclusive of other embodiments. The same applies to the term“implementation.”

As used in this application, the word “exemplary” is used herein to meanserving as an example, instance, or illustration. Any aspect or designdescribed herein as “exemplary” is not necessarily to be construed aspreferred or advantageous over other aspects or designs. Rather, use ofthe word exemplary is intended to present concepts in a concretefashion.

Additionally, the term “or” is intended to mean an inclusive “or” ratherthan an exclusive “or”. That is, unless specified otherwise, or clearfrom context, “X employs A or B” is intended to mean any of the naturalinclusive permutations. That is, if X employs A; X employs B; or Xemploys both A and B, then “X employs A or B” is satisfied under any ofthe foregoing instances. In addition, the articles “a” and “an” as usedin this application and the appended claims should generally beconstrued to mean “one or more” unless specified otherwise or clear fromcontext to be directed to a singular form.

Unless explicitly stated otherwise, each numerical value and rangeshould be interpreted as being approximate as if the word “about” or“approximately” preceded the value of the value or range.

The use of figure numbers and/or figure reference labels in the claimsis intended to identify one or more possible embodiments of the claimedsubject matter in order to facilitate the interpretation of the claims.Such use is not to be construed as necessarily limiting the scope ofthose claims to the embodiments shown in the corresponding figures.

It should be understood that the steps of the exemplary methods setforth herein are not necessarily required to be performed in the orderdescribed, and the order of the steps of such methods should beunderstood to be merely exemplary. Likewise, additional steps may beincluded in such methods, and certain steps may be omitted or combined,in methods consistent with various embodiments of the present invention.

Although the elements in the following method claims, if any, arerecited in a particular sequence with corresponding labeling, unless theclaim recitations otherwise imply a particular sequence for implementingsome or all of those elements, those elements are not necessarilyintended to be limited to being implemented in that particular sequence.

Also for purposes of this description, the terms “couple,” “coupling,”“coupled,” “connect,” “connecting,” or “connected” refer to any mannerknown in the art or later developed of joining or connecting two or moreelements directly or indirectly to one another, and the interposition ofone or more additional elements is contemplated, although not required.Conversely, the terms “directly coupled,” “directly connected,” etc.,imply the absence of such additional elements.

The present disclosure provides embodiments of plates, securing devices,systems, and associated methods that can be used to repair, for example,bone fractures, particularly ankle fractures.

Specifically, embodiments are directed to bone plating with lockingand/or non-locking fasteners for dynamic compression of bone. The holedesigns may allow for fixed angle and/or polyaxial locking and/ornon-locking of the fasteners. Some embodiments include locking fastenerswith self-forming threads configured to displace the plate material,thereby locking the fastener to the plate.

While exemplary embodiments of the plates are used to repair anklefractures, those skilled in the art will recognize that the plates maybe adapted to contact one or more of a femur, a distal tibia, a proximaltibia, a proximal humerus, a distal humerus, a clavicle, a fibula, anulna, a radius, bones of the foot, bones of the hand, or other suitablebone or bones. The bone plate may be curved, contoured, straight, orflat. The plate may have a head portion that is contoured to match aparticular bone surface, such as a metaphysis or diaphysis, flares outfrom the shaft portion, forms an L-shape, T-shape, Y-shape, etc., withthe shaft portion, or that forms any other appropriate shape to fit theanatomy of the bone to be treated.

The bone plate may be comprised of titanium, stainless steel, cobaltchrome, carbon composite, plastic or polymer—such aspolyetheretherketone (PEEK), polyethylene, ultra high molecular weightpolyethylene (UHMWPE), resorbable polylactic acid (PLA), polyglycolicacid (PGA), combinations or alloys of such materials or any otherappropriate material that has sufficient strength to be secured to andhold bone, while also having sufficient biocompatibility to be implantedinto a body. Similarly, the fasteners may be comprised of titanium,cobalt chrome, cobalt-chrome-molybdenum, stainless steel, tungstencarbide, combinations or alloys of such materials or other appropriatebiocompatible materials. Although the above list of materials includesmany typical materials out of which bone plates and fasteners are made,it should be understood that bone plates and fasteners comprised of anyappropriate material are contemplated.

The embodiments of the disclosure and the various features andadvantageous details thereof are explained more fully with reference tothe non-limiting embodiments and examples that are described and/orillustrated in the accompanying drawings and detailed in the followingdescription. The features of one embodiment may be employed with otherembodiments as the skilled artisan would recognize, even if notexplicitly stated herein. Descriptions of well-known components andprocessing techniques may be omitted so as to not unnecessarily obscurethe embodiments of the disclosure. The examples used herein are intendedmerely to facilitate an understanding of ways in which the disclosuremay be practiced and to further enable those of skill in the art topractice the embodiments of the disclosure. Accordingly, the examplesand embodiments herein should not be construed as limiting the scope ofthe disclosure, which is defined solely by the appended claims andapplicable law.

Referring to FIGS. 1-5 , a lateral distal fibula plate 100 (“plate 100”)according to a first exemplary embodiment is shown. Referringspecifically to FIGS. 1B and 5 , plate 100 is fixed to the lateralsurface 52 of a fibula 50. Plate 100 may be used to treat fractures ofthe distal fibula 50 and/or disruption of the syndesmosis, and can havea pre-contoured shape, such as is shown in FIG. 1A. Alternatively, plate100 can be contoured prior to use in order to conform to a particularbone structure.

Plate 100 has an elongate body 102 extending generally along a centrallongitudinal axis 104. Plate 100 has an upper surface 106 extendingbetween a proximal end 108 and a distal end 110 and a lower surface 107configured to be in contact with bone. A body portion 112 extendsbetween proximal end 108 and distal end 110 and has a transition section113 where body portion 112 transitions from a generally planar portion109 proximate to proximal end 108 and a contoured portion 111 proximateto distal end 110.

As used herein, the term “contoured” means “curved” such that contouredportion 111 includes surfaces (upper surface 106, lower surface 107, orboth) with non-infinite radii. The contours do not necessarily need tobe constant; the radius of curvature of contoured portion 111 can varyalong the length and width of contoured portion 111. In an exemplaryembodiment, contoured portion 111 can be contoured to match the contoursof the bone to which plate 100 is to be fixed, such as a fibula.

In an exemplary embodiment, proximal end 108 and distal end 110 eachincludes a smooth, rounded ends and edges. Body portion 112 iscontoured, with smooth, rounded edges. The smooth, rounded ends andedges eliminate the potential for inadvertently engaging and ripping anyadjoining tissue.

Body portion 112 also includes a plurality of different types ofthrough-openings formed therein and extending from upper surface 106 tolower surface 107. The different types of through-openings disclosed inplate 100 will discussed from proximal end 108 to distal end 110,although those skilled in the art will recognize that thethrough-openings can be located at different places, in differentorders, and intermixed together throughout the length of plate 100.

Referring to FIG. 3A, through-openings 114 are shaft holes including athreaded portion 116 proximate to lower surface 107 and a non-threadedportion 118 proximate to upper surface 106. Through-openings 114 mayextend along longitudinal axis 104.

Threaded portion 116 and non-threaded portion 118 are co-axial. Theshaft holes can accept both locking and non-locking screws, resulting ina “stacked” design, in which a non-locking hole geometry, non-threadedportion 118, is on top of locking threaded portion 116 below.

Through-openings 114 can alternatively receive fasteners comprised oflocking screws or non-locking (compression) screws. In exemplaryembodiments, screw 160 can be 3.5 mm or 4.0 mm screws, for example.

FIG. 3A shows a non-locking screw 160 inserted into through-opening 114.Non-threaded portion 118 is generally conical in shape such thatnon-threaded portion 118 is wider near upper surface 106 of plate 100and narrower toward threaded portion 116. Screw 160 has a substantiallysmooth convex portion 162 of a head 164 configured to be received by andengage with non-threaded portion 118 and to dynamically compress bone 50after fixation of plate 100 to bone 50. Non-threaded portion 118 has agenerally concave surface 119 to mate with convex surface portion 162 ofhead 164 of screw 160.

A shaft 166 of screw 160 has distal threads 168 that are configured toscrew into bone 50. Shaft 166 and threads 168 have a narrower diameterthan that of through-opening 114 so that shaft 166 can pass throughthrough-opening 114 without engaging threaded portion 116 ofthrough-opening 114.

A locking screw 170 is shown in FIG. 3B. Locking screw 170 has athreaded head portion 172 configured to engage threaded portion 116 ofthrough-opening 114 and to lock screw 170 to plate 100. In someembodiments, threaded head portion 172 is a self-forming thread that isconfigured to displace material in threaded portion 116 of plate 100 tolock fastener 170 to plate 100.

A second type of through-opening 120, shown in FIG. 1A, may be sized anddimensioned to allow a K-wire 174 to pass therethrough. In an exemplaryembodiment, through-opening 120 is sized to allow a 1.6 mm K-wire, topass therethrough, although those skilled in the art will recognize thatother size through-openings 120 can be provided for other size K-wires.As noted in FIG. 1A, one or more through-openings 120 are spaced along alength of plate 100 and are not necessarily aligned with longitudinalaxis 104.

A third type of through-opening that can be provided in plate 100 is anelongate slot 130. Elongate slot 130 may extend along longitudinal axis104, for example. The elongated slot 130 may have a length greater thanits width, for example, a length two times its width, a length threetimes its width, or more. Elongate slot 130 may allow for a range ofsecuring member insertion locations. In an exemplary embodiment, oneelongate through-opening 130 is provided, although those skilled in theart will recognize, depending on the length of plate 100 andthrough-opening 130, one or more than through-opening 130 can beprovided.

Slots 130 include generally smooth side walls to allow a securingmember, such as screw 160, to be inserted at infinite locations alongthe length of each slot 130. A rib 132 extends around the innerperimeter of slot 130 below upper surface 106. In an exemplaryembodiment, screws 130 can be 3.5 mm or 4.0 mm non-locking screws andcan provide up to 1 mm of compression or distraction. Screws 160 mayengage rib 132 along under surface 162 of head 164 of screw 160 so thathead 164 is largely, if not entirely, within slot 130 to minimize theamount of head 162 extending above upper surface 106 of plate 100.

Referring to FIGS. 1A and 4 , a fourth type of through-opening that canbe provided in plate 100 is a syndesmotic hole 140 located at transitionportion 113. Syndesmotic hole 140 can accept three different types offixation: (1) a suture button 190; (2) non-locking screw 160; or (3)locking screw 170.

Referring specifically to the cross-section of hole 140 in FIG. 4 , hole140 includes, from lower surface 107 of plate 100 to upper surface 106of plate 100, at least three different co-axial bores. A first boreincludes a threaded portion 142, similar to threaded portion 116 ofthrough-opening 114, with its bore having a first diameter D1.

Similar to through-opening 114, a second bore of hole 140 is has anunthreaded conical portion 144 with a conical side wall 146 locatedabove and adjacent to threaded portion 142. The second bore of hole 140has a maximum diameter D2, larger than diameter D1.

In contrast to through-opening 114, hole 140 further includes a thirdbore comprising a bowl portion 150 having a diameter D3, larger thanmaximum diameter D2. Bowl portion 150 is for the use of a suture buttonsystem that includes, for example, two metal buttons 190, 196, connectedvia suture. Button 196 interfaces with the far cortex of bone 50 (shownin FIG. 5 ), while button 190 interfaces with bone plate 100. Thisbutton system provides stability for a disrupted joint or bone fractureand also provides a type of mobile stability. The use of buttons 190,196 may be a method of treatment for the syndesmosis when thesyndesmosis is disrupted. Another type of fixation of a disruptedsyndesmosis is a bone screw as described above, which is a more rigidfixation than the suture button system.

Referring to FIG. 4 , bowl portion 150 is above and adjacent to conicalportion 146. Conical portion 146 has a maximum diameter of diameter D2proximate to bowl portion 150. Bowl portion 150 comprises a bowldiameter, larger than the maximum diameter. The transition between bowlportion 150 and threaded portion 142 (i.e. conical portion 144) is shownin FIG. 4 as a chamfer, but could alternatively be a round.

Bowl portion 150 includes a side wall 152 that circumscribes bowlportion 150 and an annular surface 154 between the side wall 152 andconical portion 144. Annular surface 154 surrounds side wall 146 ofconical portion 144. Bowl portion 150 is configured to receive andretain a button 190 having a lower surface 192 (shown in FIG. 5 )configured to engage annular surface 154 and fit within side wall 152.

Referring to FIG. 1A, button 190 also includes at least one thread hole194 that is in communication with hole 140 when lower surface 192 is inengagement with annular surface 154.

Referring to FIG. 5 , first button 190 is configured for insertion intobowl portion 150 of hole 140 and a second button 196 is configured toengage bone 50, distal from bone plate 100. A suture (not shown) extendsthrough thread hole 194, through plate 100 and a passage 54 drilledthrough bone 50, to second button 196 to compress bone 50 and plate 100between buttons 190, 196.

A fifth set of through holes 158 are provided at distal end 110 of plate100. Holes 158 may be configured to receive locking screws 198. In anexemplary embodiment, holes 158 may be threaded to accept 2.5 mm lockingscrews 198, for example. A plurality of holes 158 (about seven as shownin plate 100) are provided to fix distal end 110 of plate 100 securelyin bone 50. Holes 158 are not constrained along longitudinal axis 104but instead are located along the width of plate 100 to provide aplurality of screw connections for a secure fixation to bone.

FIG. 2A depicts an alternative version of a lateral distal fibula plate100. FIGS. 2B and 2C show close up views of the distal portion of theplate 100. The plate 100 is substantially the same as that disclosed inFIG. 1A, with the addition of a sixth type of through hole 180. Thisthrough hole 180 may be a non-threaded hole located within the distalhead of the plate 100. Through hole 180 may have smaller diameter thanthe other distal through holes 158. The through hole 180 may bepositioned near or surrounded by distal locking holes 158. The throughhole 180 may be configured accept a non-locking fastener or screw 160that can act as a suck-down screw. In a preferred embodiment, this hole180 is not threaded. When used, the non-locking screw 160 may be placedfirst in order to get the plate 100 to be compressed down to the bone50. This screw 160 can be left in after the other distal locking screws198 are placed in holes 158 or screw 160 can be removed. As shown inFIGS. 2A-2C, the middle non-threaded hole 180 is configured to acceptthe non-locking screw 160, but it is envisioned that either a proximalor distal non-threaded hole 180 could accept a non-locking screw 160.

A second embodiment of a plate 200, shown in FIG. 6A, is aposterolateral distal fibula plate. Plate 200 sits on the posterior faceof the fibula distally, and wraps around to the lateral surface as plate200 travels proximally. Plate 200 can be used to facilitate a posteriorsurgical approach. Similar to plate 100, plate 200 can have a variety ofdifferent through-openings, including syndesmotic holes 240, similar tosyndesmotic holes 140 described above.

Plate 200 has a generally planar body 202 with a transition portion 213proximate to syndesmotic holes 240, where body 202 transitions to acontoured shape to conform to the posterior face of the fibula.

FIG. 6B depicts an alternative version of posterolateral distal fibulaplate 200. The plate 200 is substantially the same as that disclosed inFIG. 6A, with the addition of one or more scalloped edges 182. Thescalloped edge or edges 182 may be positioned along the transitionregion 213 of the plate 200. The scalloped edge 182 may extend along oneor both sides of the plate 200. As shown, the scalloped edge 182 may bepositioned on a first side of the plate 200. The scalloped edge 182 mayinclude a first recess or cutout positioned along the edge between thesecond and third syndesmotic holes 240 and a second recess or cutoutpositioned along the edge between the third syndesmotic hole 240 and thefirst locking hole 158. Because the posterolateral plate 200 isconfigured to sit on the posterior side of the fibula 50, syndesmoticscrews 160, 170 (placed lateral to medial) or suture buttons 190 oftencannot be placed through the plate 200. In some embodiments, thesescallops 182 are configured to allow additional screws or suture buttonsto be placed outside of the plate 200 and aids in these treatmentoptions by not directly contacting the plate 200. In some embodiments,one or more fasteners (e.g., screws 160, 170) may be placed outside theplate 200, but in close proximity or in contact with the scalloped edge182.

A third embodiment of a hook plate 300 (“plate 300”) is shown in FIGS.7-9 . Plate 300 can be used for very distal fractures of the tibia orfibula, for example. Hook plate 300 has an elongate body 302 extendinggenerally along a central longitudinal axis 304. Plate 300 has agenerally planar top surface 306 extending between a proximal end 308and a distal end 310. A body portion 312 extends between proximal end308 and distal end 310. Plate 300 is symmetrical about a plane extendingthrough central longitudinal axis 304 perpendicular to top surface 306.

In an exemplary embodiment, proximal end 308 includes a smooth, roundedface. The smooth, rounded face eliminates the potential forinadvertently engaging and ripping any adjoining tissue.

Body portion 312 is generally planar, with smooth, rounded surfaces,again to eliminate the potential for inadvertently engaging and rippingany adjoining tissue. Body portion 312 also includes a plurality ofthrough-openings 314 formed therein. Through-openings 314 are elongateslots and allow for a range of securing member insertion locations. Inan exemplary embodiment, two elongate through-openings 314 are provided,although those skilled in the art will recognize, depending on thelength of plate 300 and through-openings 314, more or less than twothrough-openings 314 can be provided.

Through-openings 314 include generally smooth side walls to allowsecuring members 318 to be inserted at infinite locations along thelength of each through-opening 314. A rib 320 may extend around theinner perimeter of through-opening 314 below top surface 306. In anexemplary embodiment, securing members 318 can be 3.5 mm or 4.0 mmnon-locking screws and can provide up to 1 mm of compression ordistraction. Securing members 318 engage rib 320 along an under surfaceof the head 322 of securing member 318 so that head 322 is largely, ifnot entirely, within through-opening 314 to minimize the amount of head322 extending above top surface 306 of plate 300.

Through-openings 316 may be located at either end of plate 300.Through-openings 316 are shaft holes that can accept either one oflocking and non-locking screws via the “stacked” design described above.A first through-opening 316 is located at proximal end 308 and a secondthrough-opening 316 is located at distal end 310.

Referring to FIGS. 8 and 9 , distal end 310 includes an arcuate surface330 that extends away from the plane of body portion 312, and is used tocapture the distal bone fragment of either the tibia or the fibula.Arcuate surface 330 extends in an arc having an angle β of between about100 degrees and about 160 degrees, about 125 degrees and about 155degrees, or about 135 degrees and about 150 degrees from body portion312. At least one through-opening 316 extends through arcuate surface330.

A most distal end 332 of arcuate surface 330 includes a hook assemblyhaving two separate hooks 334, 336. Each hook 334, 336 includes a flatsurface 335, 337, respectively and each flat surface 335, 337 includes acorresponding cutting edge 338, 340, respectively. Cutting edges 338,340 extend along a single line 342 that is perpendicularly skew tolongitudinal axis 304 and are used to engage and dig into bone materialin the tibia or fibula.

With the exception of cutting edges 338, 340, all edges of arcuatesurface 330 and hooks 334, 336 have smooth, rounded surfaces, again toeliminate the potential for inadvertently engaging and ripping anyadjoining tissue.

FIG. 10A depicts an embodiment of a universal distal fibula plate 500.In FIG. 10B, the universal distal fibula plate 500 is positioned againsta distal portion of the fibula 50. This plate 500 is similar to thelateral distal fibula plate 100 described above. Plate 500 has anelongate body 502 extending generally along a central longitudinal axis504. The plate 500 has a transition section 513 between proximal end 508and distal end 510 where body 502 transitions from a generally planarportion proximate to proximal end 508 to an enlarged head portionproximate to distal end 510. The enlarged head portion may have a widthgreater than the width of the remainder of the plate 500. The enlargeddistal head portion of the plate 500 may be bent or contoured to mimicthe anatomy of the fibula 50 (e.g. the lateral malleolus of the fibula).In an exemplary embodiment, proximal end 508 and distal end 510 eachincludes smooth, rounded ends and edges. The plate 500 is generallysymmetric about the longitudinal axis 504, such that plate 500 canaccommodate left or right fibulas.

Similar to plate 100, plate 500 includes a plurality of different typesof through-openings formed therein and extending therethrough.Through-openings 514, similar to through-openings 114 described herein,may feature a “stacked” design where the holes can accept both lockingand non-locking fasteners 160, 170 or screws. In exemplary embodiments,the openings 114 are configured to accept fasteners including 3.5 mm or4.0 mm screws, for example. Through-openings 514 may extend alonglongitudinal axis 504. Through-openings 520, similar to through-openings120, may be sized and dimensioned to allow a K-wire to passtherethrough. Through-opening 530, similar to elongate slot 130, mayextend along longitudinal axis 504, for example. Syndesmotic openings540, similar to syndesmotic holes 140, are each configured to accept asuture button 190, a non-locking screw 160, or a locking screw 170. Inparticular, the syndesmotic holes 540 can accept 3.5 mm or 4.0 mmlocking or non-locking screws. As best seen in FIG. 10B, at least one ofthe fasteners is positioned through the syndesmotic hole 540 has alength sufficient to engage the fibula 50 and the tibia 54. As shown, anon-locking fastener 160 connects the plate 500 to the fibula 50 and thetibia 54. In this embodiment, the other fasteners 160, 170 have a lengthsufficient to only engage the fibula 50.

Through-openings 558, similar to through holes 158, are provided in theenlarged distal head portion at the distal end 510 of plate 500. Theseholes 558 may be conically-threaded locking holes configured to receivelocking fasteners 198. Holes 558 may be located along the width of plate500 to provide a plurality of screw connections for a secure fixation tothe fibula 50. One or more of the holes 558 may be replaced with anon-threaded hole 180 as described for the lateral distal fibula plate100, which may be configured accept a non-locking fastener or screw 160that can act as a suck-down screw. Plate 500 is universal and configuredto secure the bone on left or right fibulas.

The bone plates 100, 200, 300, 500 described herein may be especiallyconfigured for treatment of an ankle fracture. In particular, theseplates 100, 200, 300, 500 may be especially suitable for treatment ofthe distal fibula including lateral distal fibula or the posterolateraldistal fibula, and/or the distal tibia. These anatomic bone plates 100,200, 300, 500 may facilitate improved treatment methods of anklefractures and can provide a number of treatment options based on surgeonpreference.

Although the invention has been described in detail and with referenceto specific embodiments, it will be apparent to one skilled in the artthat various changes and modifications can be made without departingfrom the spirit and scope of the invention. Thus, it is intended thatthe invention covers the modifications and variations of this inventionprovided they come within the scope of the appended claims and theirequivalents. It is expressly intended, for example, that all rangesbroadly recited in this document include within their scope all narrowerranges which fall within the broader ranges. It is also intended thatthe components of the various devices disclosed above may be combined ormodified in any suitable configuration. Thus, the features of oneembodiment may be added or combined with the features of anotherembodiment.

What is claimed is:
 1. A distal fibula plate system comprising: a boneplate having: an enlarged head having a curvature adapted to lie over adistal fibula bone and a plurality of bone screw holes; a transitionportion extending proximally from the head and having at least onesyndesmotic hole shaped to accept any one of a locking screw, anon-locking screw and a suture button; a shaft extending proximally fromthe transition portion and having a central longitudinal axis, the shafthaving an elongate slot configured to accept a bone screw forcompression of the fibula bone, wherein the at least one syndesmotichole and the elongate slot lie along the central longitudinal axis, andthe at least one syndesmotic hole is disposed distally of the elongateslot; and a fastener configured to engage one of the plurality of bonescrew holes and the at least one syndesmotic hole; wherein the at leastone syndesmotic hole includes a threaded portion proximate to a lowersurface of the bone plate and a non-threaded portion overlying thethreaded portion; and wherein the non-threaded portion comprises aconical portion, adjacent to the threaded portion and a bowl portion,adjacent to the conical portion.
 2. The distal fibula plate systemaccording to claim 1, wherein the non-threaded portion is conical inshape such that the non-threaded portion is wider near an upper surfaceof the bone plate and narrower toward the threaded portion.
 3. Thedistal fibula plate system according to claim 1, wherein thenon-threaded portion has a concave surface.
 4. The distal fibula platesystem according to claim 1, wherein the fastener has a threaded headportion configured to engage the threaded portion and to lock to thebone plate.
 5. The distal fibula plate system of claim 4, wherein thethreaded head portion comprises a self-forming thread configured todisplace material in a threaded portion of the at least one syndesmotichole to lock the fastener to the bone plate.
 6. The distal fibula platesystem according to claim 1, wherein the fastener has a substantiallysmooth head portion configured to engage the non-threaded portion and todynamically compress the fibula bone.
 7. The distal fibula plate systemaccording to claim 1, wherein the conical portion has a maximum diameterproximate to the bowl portion and wherein the bowl portion comprises abowl diameter, larger than the maximum diameter.
 8. The distal fibulaplate system according to claim 1, wherein the bowl portion comprises aside wall and an annular surface between the side wall and the conicalportion.
 9. The distal fibula plate system according to claim 8, whereinthe bowl portion is configured to receive and retain a button located onthe annular surface and within the side wall.
 10. The distal fibulaplate system according to claim 9, wherein the fastener comprises abutton having a lower surface configured to engage the annular surfaceand at least one thread hole in communication with the at least onesyndesmotic hole when the lower surface is in engagement with theannular surface.
 11. The distal fibula plate system of claim 1, wherein:the plurality of bone screw holes of the enlarged head include lockingscrew holes; and the shaft further includes a plurality of shaft holesadapted to accept both a locking screw or a non-locking screw.
 12. Thedistal fibula plate system of claim 11, further comprising a k-wire holedisposed between the elongated slot and the plurality of shaft holes.13. A distal fibula plate system comprising: a bone plate having: anenlarged head having a curvature adapted to lie over a distal fibulabone and a plurality of bone screw holes; a transition portion extendingproximally from the head and having at least one syndesmotic hole shapedto accept any one of a locking screw, a non-locking screw and a suturebutton; a shaft extending proximally from the transition portion andhaving a central longitudinal axis, the shaft having an elongate slotconfigured to accept a bone screw for compression of the fibula bone,wherein the at least one syndesmotic hole and the elongate slot liealong the central longitudinal axis, and the at least one syndesmotichole is disposed distally of the elongate slot, the at least onesyndesmotic hole including a threaded portion proximate to a lowersurface of the bone plate and a non-threaded portion proximate to anupper surface of the bone plate; a locking fastener configured to engagethe at least one syndesmotic hole, wherein the locking fastener has athreaded head portion configured to lock to the bone plate; and acompression fastener configured to be received by the elongate slot andto be inserted into the fibula bone, wherein the compression fastenerhas a substantially smooth portion configured to dynamically compressthe fibula bone; wherein the non-threaded portion comprises a conicalportion, adjacent to the threaded portion and a bowl portion, adjacentto the conical portion.
 14. The distal fibula plate system according toclaim 13, wherein the locking fastener is configured to be received bythe conical portion.
 15. The distal fibula plate system according toclaim 13, wherein the locking fastener is configured to be received bythe bowl portion.
 16. The distal fibula plate system according to claim15, further comprising a first button configured for insertion into thebowl portion and a second button configured to engage the fibula bone,distal from the bone plate.
 17. The distal fibula plate system accordingto claim 13, wherein the threaded head portion is a self-forming threadconfigured to displace material of the bone plate to lock the fastenerto the bone plate.